title: [Case of hot tub lung with confirmation of exacerbation following jet bath use].
abstract: A 49-year-old woman presented with exertional dyspnea. Chest CT revealed patchy areas of ground-glass attenuation and ill-defined centrilobular nodules scattered in both lungs. Bronchoalveolar lavage (BAL) fluid showed lymphocytosis. Transbronchial lung biopsy revealed bronchiolocentric alveolitis and well-formed non-necrotizing granulomas were present. She had used a jet bath before the onset of symptoms and mycobacterial culture revealed the presence of Mycobacterium avium complex (MAC) in sputum sample, BAL samples and jet bath water. Restriction fragment length polymorphism (RFLP) analysis revealed that the isolated MAC were essentially clonal. She had used the jet bath for the inhalation provocation study, and after the challenge she complained of dyspnea and have body temperature increased. We diagnosed hot tub lung due to Mycobacterium avium complex. Because avoidance of the jet bath caused improvement of her symptoms and reduced her fever and PaO2 increased by 10 Torr but did not improve the CT findings, antimycobacterial drugs were prescribed. The patient recovered fully. This case proves that the cause of hot tub lung is the use of jet bath through the inhalation provocation study.
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Noriko
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Yoneda
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Miyahara
authors.forename: Nasa
authors.initials: N
authors.lastname: Morokawa
authors.forename: Shozaburo
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Daidou
authors.initials: D
authors.lastname: Tokunaga
authors.forename: Hiroo
authors.initials: H
authors.lastname: Saito
authors.forename: Mikio
authors.initials: M
authors.lastname: Ubukata
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kurashima
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kawabata
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification*; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014871:Water Microbiology
chemical_list: D000995:Antitubercular Agents